Two very interesting articles arguing that we are overreacting to the bird flu thing. The vets who remember the SARS scare may relate.

(1) http://www.washingtonpost.com/wp-dyn/content/discussion/2005/10/14/DI2005101401462.html

(2) http://www.latimes.com/news/opinion/commentary/la-oe-siegel11oct11,0,1462855.story?coll=la-news-comment-opinions, which is quoted below,



An epidemic of overreaction

By Marc Siegel, MARC SIEGEL is an internist and associate professor at the New York University School of Medicine. He is the author of "False Alarm: The Truth about the Epidemic of Fear" (Wiley, 2005).

"THIS PAST WEEK, my patients seemed more nervous than usual. In addition to concerns about chest pain, coughs and fevers, there were also the sudden, uneasy questions about bird flu.

"Should I be taking Tamiflu?" several asked. "Can you prescribe it so I have a supply on hand just in case?"

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My answer was always the same. "No. Tamiflu is an antiviral drug that has not yet been proved effective against bird flu. And even if it worked, there's still no bird flu to treat."

The difficulty with informing the public about a potential pandemic is that the uncertainty about when or if it could occur breeds fear. Scared people over-personalize the news, and their worries increase. Fear is a warning system intended to alert us to impending danger. The bird flu, though a potential large-scale danger, is not impending.

The facts are these: The current H5N1 avian influenza virus has not mutated into a form that can easily infect humans, and the 60 people in the world who have died of this bird flu have done so not because this bug is on the road to mutation but because millions of birds throughout Asia have been infected, and the more birds that have it, the more likely that an occasional human bird handler will be infected.

Most human influenzas begin as bird flus, but many bird flus never change to a form that can harm us. Though flu pandemics occur on the average of three times per century, and we are clearly overdue (the last was in 1968), there is absolutely no indication that the transformation to mass human killer is about to happen. The threat is theoretical. Unfortunately, the attention it has received makes it feel like something terrible is inevitable.

Why the overreaction? For one thing, direct comparisons to the Spanish flu of 1918, a scourge that killed more than 50 million people worldwide, has alarmed the public unnecessarily. In fact, there are many scenarios in which the current bird flu won't mutate into a form as deadly as the 1918 virus.

And even if we accept the Spanish flu scenario, health conditions in 1918 were far worse in most of the world than they are now. Many people lived in squalor; 17 million influenza deaths occurred in India, versus about half a million deaths in the U.S. There were no flu vaccinations, no antiviral drugs, and containment by isolating infected individuals wasn't effective, largely because of poor information and poor compliance. Today's media reach could be a useful tool to aid compliance. Of course, the concern that air travel can spread viral infections faster may be valid, but infected migratory birds were sufficient in 1918.

Unfortunately, public health alarms are sounded too often and too soon. SARS was broadcast as a new global killer to which we had zero immunity, and yet it petered out long before it killed a single person in the United States. SARS was something to be taken seriously, but the real lessons of SARS, smallpox, West Nile virus, anthrax and mad cow disease weren't learned by our leaders — that potential health threats are more effectively examined in the laboratory than at a news conference.

With bird flu, scientists have been working on the structure of the viruses in an attempt to protect us. Studies published in the journals Nature and Science over the last six years have given scientists a road map with which to track the current bird flu and alert health officials if it mutates further. It is reasonable to try to control the bird flu while it remains in the bird population. There is great value in improving our emergency health response system and upgrading our vaccine-making capacity. Government subsidies in these areas could make the public safer.

But, right now, there is no value in scaring the public with Hitchcockian bird flu scenarios. The public must be kept in the loop, but potential threats should be put into context. The worst case is not the only case."

It's not medicine, it's politics, at least in the USA

Think about it, if you're worried about the bird flu, you may not pay too much attention to Delay and Libby getting indicted, or of passing the 2000 number of dead in Iraq. Do you wonder why Bush started talking a few weeks ago about "pandemic" and using the military to help in a domestic health crisis? It's amazing how every time the Pres gets into trouble, there's a new crisis to crop up and divert attention.

Cat, I agree, I'm as cynical as they come about politicians and this one takes the cake. Nothing like an international crisis (they used to make war in the past) to get peoples' minds off domestic problems.

Now this Orent lady better encapsulates her theories in a recent commentary:

http://www.latimes.com/news/opinion/commentary/la-op-bird23oct23,0,4915529.story?coll=la-news-comment-opinions

Orent makes an interesting point, it is self-defeating for a virus to mutuate to a fatal virulency...i.e. if the virus gets so virulent that it kills its hosts each time, then the virus is committing genetic suicide as it won't be able to spread.

I'd like to make the point that SARS may well have not become a major problem because of an "overreaction." Similarly with the bird flu, the only way to prevent a large number of deaths might be to "overreact." We KNOW flu has the potential to kill tens of millions, and it's only because of our current technology and watchdogs like the CDC and other organizations that it's an issue in the media now. Of course the media overreacts to everything and sensationalizes the news, playing up fear especially, to attact viewers. It's possible that in the case of communicable disease, a culture of fear is a good thing.

Orent's point of a fatal virus being self-defeating is a non-starter. So what if it doesn't survive? It's just a genetic dead end, going extinct, and nature keeps going. Humans don't however. Look, flu can be transmitted before the host even shows symptoms. Flu can be transmitted like wildfire. There's no selection effect to stop a fatal flu from spreading.

The bird flu is a very serious threat, and while there are scenarios where it never materializes, there are many contrary scenarios.

It makes sense to be prepared to curtail travel and take precautions in the event it mutates (which could be more "impending" than applied). There are things the media hypes, like terrorism, with government alert colors, that are pretty ridiculous. Or kidnapping/murder cases involving pretty young white girls.

The bird flu though, even the people here saying that its overhyped admit it could be a very serious problem. They're just arguing the hype is too much, without enough context.

I'm not trying to scare anyone, not at all, but I think this is more serious news than all the political scandals, which I don't think are really surprising anyone. Something like half the people in DeLay's own district want him to resign, so that news is getting through.

Good points Broman, and I certainly didn't want to imply that we shouldn't be concerned or laugh this bird flu off. IMO, it's just that too much of anything, espec. panic/overreaction, is never good. I still think it's highly coincidental that this overreaction is being played up now by the opportunistic politicians. Also, like any debate, a healthy counterpoint is needed and until now, I really haven't seen the counter arguments being made, let alone get picked up by the media.

I also agree w/ you that a flu may be transmitted before symptoms appear, but this seems to fit in with Orent's theory. In other words, the bird flu found in the few human victims so far is supposedly so virulent that it incapacitates its host in a day(s), and kills it's human victim soon thereafter. A genetic deadend as the infected and dead individual can't spread the virus. Orent would probably argue, that the flus that you speak about -- the ones that are easily transmitted, even prior to symptoms -- have probably mutated to a a less virulent form as this latter type of flu has not killed its host and benefits from this sick host moving about and spreading the virus to others.

From what I understand, it's very likely a human-to-human version of the bird flu won't be quite as deadly, but flu is easy to transmit and even a much lower fatality rate of 10-20% would be devestating. The thing here too is that younger, healthier people are dying, not just the old and weak, which is the scary part to me.

It's worth watching for information.

"panic/overreaction, is never good"

During the SARS hysteria, Northwest had SAN-BKK airfares for $399 total, tax included.

EVA was giving 10,000 bonus miles per segment LAX-TPE.

Cathay Pacific had some awesome deals.

Flights were half empty meaning you were assured a whole row of seats to yourself to sleep in even in economy.

panic/overreaction IS good

Bird flu is going to kill everyone who steps off a plane in Asia and the US military will block you at the border when you try to come back to America. Everyone cancel your plans at once. ;)

LOL IAS, I admit that I also took advantage of the SARS scare and got some great fares during that time to SEA, I miss those days of flying on a 747 that was 1/2 empty?

Low fares are a silver lining. I decided not to make a business trip to China during the SARS stuff. I was busy, and didn't "need" to make it, so while I didn't think there was much of a chnace I'd get SARS, I didn't travel.

People keep telling my I need to get to Thailand, however...the big drawback of course is that this hobby kind of ensures exposure to a lot of germs going around, so if the flu does take off and there isn't a vaccine yet, it's a problem.

IAS

You know, I was thinking the SAME THING!! I was booking Deluxe tix for $399 during SARS. People would ask me "aren't you afraid of SARS?!?!" They were just certain there were dead bodies littering the streets of every country in SEA. They just couldn't understand it was business as usual in Asia for the most part. Hell, I remember I was in AC once and sneezed - all the girls pointed at me, yelled SARS and immediately burst into laughter!!

Broman

Don't fuck the ones that cough

E

"Ordinary flu" vs Avian Flu

From the US CDC

"Every year in the United States, on average:
* 5% to 20% of the population gets the flu;
* more than 200,000 people are hospitalized from flu complications, and;
* about 36,000 people die from flu."

For Avian flu

5 people have died in Thailand
42 people TOTAL have died worldwide.

Seems pretty good odds to me.

I could probably think of tens of thousands of things more likely to kill you than bird flu. I wonder how many lives are lost annually slipping on tile floors after showering in Thai hotel rooms. I bet WAY more than 5. (almost lost my own life that way a few times)

Yeah, you know what was funny is that during the SARS thing, at arrival in SEA, I'd remember nurses in Hazmat Nasa suits who'd check for fever with those cheap disposal thermometers that made your throat itch. A Set up I tell you, one cough and you'd be in quarantine.

In Koh Kong Cambodia their SARS screening was so successful, they continue it to this day, and try to extort $1 out of you for the privilege.

Bird flu? Damn, if it is not one thing, it is another. How and the hell am I going to be able to force-feed Nyquil to my parrot? That bitch will bite my fingers off.

Epi,

If you sneezed around me, I'm sure I would fucking cringe. You may not have SARS but I'm sure you have something contagious

Ok, maybe it's not contagious, but I'm sure one of the Orient Mongers with your barebacking LBFMs day and night is incubating something or other. Actually, it's probably I Am Sancho.

I_am_sancho, it's more like 61 deaths worldwide, and I would laugh at that, too.

The bird flu in its current form IS something to sneeze at. No one is worried about it.

People are worried about it mutating to a form that can pass from human to human, which flus do on a regular basis. If/when that happens, it's a viable threat. Before then, I'd be happy to get a $399 ticket to SEA.

Epimetheus, about the girls who cough. OK, I won't fuck them. But I can help them with their cough by getting a BJ, right? I understand sucking on hard candy is good for a cough.

Damn...what does it take to get someone to comment on your post around here? Perhaps advise on getting a brasilian visa or suggesting a good movie?????

<goes>

>Every year in the United States, on average:
>5% to 20% of the population gets the flu

The thing that concerns everyone about another Spanish flu type bug is there's still precious little anyone can do to reduce the number of people who get sick, no matter how deadly the flu bug.

>Though flu pandemics occur on the average of three times per century, and we are clearly
>overdue (the last was in 1968), there is absolutely no indication that the transformation
>to mass human killer is about to happen. The threat is theoretical.

I would definitely argue that the threat is far from "theoretical" - more like inevitable. The question is, how imminent is the threat? And no one knows the answer to that one. Chances are the current bird flu won't be "the one", and it will probably disappear with little consequence. (Apparently it's missing several genetic changes that made the 1918 bug particularly nasty.) But sooner or later nature will happen upon another 1918 style killer. It'd be nice if we found a FAST way to make antivirals and/or vaccine before then.

I know a couple of American guys who won't eat chicken in Asia because of the bird flu. Ironically, American beef was (and perhaps still is) banned in a lot of Asian countries because of the mad cow disease.

Even the very best steakhouses in HK were only selling Austrailian beef. Yuck.

Since I haven't stopped eating beef in the US, I won't stop eating chicken in Asia.

Well some good news about a promising and potent vaccine breakthrough for the bird flu.

http://www.latimes.com/la-na-birdflu27jan27,0,415814.story?coll=la-home-headlines

Let's keep our fingers crossed.

> "Every year in the United States, on average:
> * 5% to 20% of the population gets the flu;
> * more than 200,000 people are hospitalized from > flu complications, and;
> * about 36,000 people die from flu."

> For Avian flu

> 5 people have died in Thailand
> 42 people TOTAL have died worldwide.

I don't know where this comes from. According to the World Health Organization, the current total is 152 cases, with 83 deaths. That incorporates 9/7 from 2006 as of 25 January 2006.

The mortality seems to be trending downwards (it started at 100% with 3/3 in 2003), and so now if "5% to 20%" of the U.S. population gets an H5N1 influenza, we can look forward to somewhere between 2.75% and 11% of the U.S. population (8 to 32 million people) being dead.

> Seems pretty good odds to me.

Me too, but what are we betting on? Those kinds of megadeaths will tend to bump the share prices of certain mortuary-related stocks, but otherwise?

Well, at least the people in New Orleans will stop playing "how tragic it is to be me" on the national news...

Dem Optimistic Gnomes

"we can look forward to somewhere between 2.75% and 11% of the U.S. population (8 to 32 million people) being dead."

"Those kinds of megadeaths will tend to bump the share prices of certain mortuary-related stocks, but otherwise?"

Those kind of numbers are big enough to pretty much trash the world enconomy, also while the reaper prowls people will most likely not go to work and live in complete fear of any other human they see. I think it's safe to say we would be looking at a crash and burn that the world would not recover from for decades. That being said no one knows what the mortality rate will be if and when the virus jumps the species barrier to us.

It's a fair assumption that the human race is just as prone to plagues and epademics as it has always been and it's just a matter of time before the next "Catagory 5" virus hits, but it might not be this one

I used to worry about bird flu when all I could find was the occasional stray article on it. A year ago at this time it wasn't getting much mention in the western press, but was covered regularly in SE Asian papers.
Now CNN and the rest of them have gone ga-ga over it, in the same spirit as when they camped out in tents outside Sharon's hospital.
I don't worry about it anymore.
By the way, there has been a strain of avian flu decimating the wild birds in the eastern US for years. Guess they forget to mention that, what with all those award shows and celebrity couplings to report on.